Podcast Summary: Freakonomics Radio – "How to Succeed at Failing, Part 2: Life and Death (Update)"

Release Date: May 14, 2025

In the poignant second installment of the "How to Succeed at Failing" series, Freakonomics Radio delves deep into the critical realm of healthcare failures, where mistakes can have life-or-death consequences. Host Stephen Dubner engages with experts and individuals whose experiences shed light on the multifaceted nature of failure within the medical system.

Tragic Personal Loss: Carol Hemmelgarn’s Story

The episode opens with the heartrending account of Carol Hemmelgarn, whose daughter Alyssa died of leukemia due to multiple medical errors in 2007. Hemmelgarn recounts the systemic issues that led to her daughter's untimely death:

Carol Hemmelgarn [02:06]: "In nine days she died from multiple medical errors... they kept giving her drugs for anxiety... they wouldn't listen to me."

This tragedy propelled Hemmelgarn to advocate for patient safety, leading her to co-found Patients for Patient Safety USA and teach a master's program at Georgetown University focused on Clinical Quality Safety Leadership.

Understanding Failure in Healthcare

Building upon the initial discussion, Hemmelgarn emphasizes the necessity of transparency in healthcare to prevent future tragedies:

Carol Hemmelgarn [05:08]: "When harm does reach the patient or family, that is the time to really analyze what happened... we have to have transparency."

She highlights the reluctance of institutions like Vanderbilt University Medical Center to take responsibility in the case of wrongful prosecution of nurse Redonda Vaught for a medication error, underscoring the systemic nature of such failures.

Amy Edmondson’s Spectrum of Failure Causes

Organizational psychologist Amy Edmondson introduces a nuanced framework to categorize failures, moving beyond the simplistic blame-and-shame approach. Her "Spectrum of Causes of Failure" ranges from blameworthy to praiseworthy, encompassing six distinct categories:

1. Sabotage/Deviance [23:19]: Intentional actions aimed at causing failure.

   Amy Edmondson [23:19]: "On one end of the spectrum, it's sabotage... Or I'm a surgeon who operates drunk."

2. Inattention [24:23]: Failures due to negligence or lack of focus, often influenced by external factors like overwork.

   Amy Edmondson [25:47]: "Why weren't they paying attention? Maybe the nurse was on a double shift..."

3. Inability [26:59]: Lack of necessary knowledge or skills to perform a task effectively.

   Amy Edmondson [26:59]: "A young child who doesn't yet know how to ride a bicycle... multivariable calculus."

4. Task Challenge [28:38]: Failures arising from the inherent difficulty of a task.

   Amy Edmondson [28:38]: "An Olympic gymnast... inability to perform a maneuver 100% of the time."

5. Uncertainty [30:48]: Failures caused by unpredictable factors beyond one’s control.

   Amy Edmondson [30:48]: "A blind date turning out terribly... strategic shifts in companies."

6. Experimentation [31:37]: Failures resulting from testing new ideas or approaches, viewed positively as learning opportunities.

   Amy Edmondson [31:37]: "A scientist hypothesizing a new tweak... Edison’s 10,000 failed experiments."

Case Studies Illustrating the Spectrum

The podcast presents two contrasting case studies to exemplify the spectrum:

1. Blameworthy Failure – NHS's IT Fiasco:

   John Van Reenen narrates the catastrophic failure of the UK's Connecting for Health project, a centralized IT system overhaul for the National Health Service. Despite high hopes and significant investment (estimated losses up to $20 billion), the project collapsed due to inadequate understanding of grassroots needs, rushed contract awards, and cultural resistance within the fragmented healthcare system.

   John Van Reenen [36:55]: "It was very much driven by the Prime Minister, Tony Blair... the biggest civilian IT project in the Western world."

2. Praiseworthy Failure – Bob Langer’s Scientific Endeavors:

   Renowned MIT scientist Bob Langer shares his relentless pursuit of breakthroughs in drug delivery systems. Despite over 200 failed experiments, Langer's perseverance led to innovations critical for Moderna's COVID-19 vaccine development. His story underscores the value of viewing failures as essential steps toward significant achievements.

   Bob Langer [46:28]: "I failed at trying to get research grants. My first nine research grants were turned down... I failed over and over again."

Insights on Embracing Failure

Amy Edmondson advocates for a cultural shift in handling failures, especially in high-stakes environments like healthcare:

Amy Edmondson [18:57]: "Responses to failure were rather uniform... it's really a systemic problem."

Gary Klein, a research psychologist, echoes this sentiment, praising Edmondson's sophisticated spectrum for its ability to differentiate types of failures and inform more effective strategies.

Gary Klein [33:36]: "It's sophisticated, not simplistic... we need to identify what kind of failure it is."

Scientific and Entrepreneurial Perspectives on Failure

Bob Langer discusses the importance of perseverance in scientific research and entrepreneurship, highlighting that failures are integral to innovation:

Bob Langer [53:20]: "Research, scientific research, you just fail way more than you succeed... It's part of the process."

He contrasts this with other perspectives, noting that while some criticize the glorification of failure, his experiences affirm its role in meaningful progress.

Conclusion: Rethinking Failure

The episode challenges listeners to reconceptualize failure not merely as a setback but as a spectrum of causes that require tailored responses. By embracing this nuanced understanding, especially in critical fields like healthcare and scientific research, society can foster environments that learn and grow from failures rather than stigmatize them.

As the series progresses, the next episode promises to further explore the balance between grit and the wisdom to know when to quit, providing actionable insights for personal and professional resilience.

Notable Quotes:

• Carol Hemmelgarn [02:06]: "In nine days she died from multiple medical errors... they wouldn't listen to me."

• Amy Edmondson [23:19]: "On one end of the spectrum, it's sabotage... Or I'm a surgeon who operates drunk."

• Bob Langer [46:28]: "I failed over and over again. Other things... I failed over 200 times before I finally got something to work."

• Gary Klein [33:36]: "Before we start making policies about what to do about failure, we need to look at things like her spectrum."

This comprehensive exploration into the dynamics of failure provides valuable lessons on accountability, systemic improvement, and the importance of a culture that learns from mistakes to safeguard lives and advance knowledge.